Tagged "bite block hierarchy"

Ask A Therapist: Bite Block & Tongue Depressor Questions

Posted by Deborah Grauzam on

I have a student who is using the red bite blocks. He just started. When I put the bite block #2 between his teeth he slides them over. Is this normal or should I reposition them?

I have another student who is having a very hard time holding the tongue depressor between his lips. He has a hard time dissociating between his lips and his tongue and jaw. His tongue is retroflex for l. He is currently working in l in the final positing of words and is having a hard time bringing the tongue forward and not back. Any advice?




Hi Rebecca

I would definitely reposition. I often have to have the patient bite a couple of times until it is positioned correctly especially with patients with severe weakness. You may even want to practice the biting without the bite block for correct position first and then go in with the bite block. Sometimes that helps as well. 

As far as the second part of the question, I would make sure that I have addressed any jaw weakness first. That is typically the foundation of the issue. As far as the tongue placement I would work on stimulating with the toothette the forward placement of the tongue. I would touch with the toothette on the alveolar ridge where you want the tongue tip to touch and then I would touch the tip of the tongue with the toothette. You can use vibration with the toothette if your client will accept that. This has helped many patients I have worked with find the appropriate placement. 

Please let me know if you have any other questions. We are always here and happy to help.




Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 11 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy.  She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

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Ask a Therapist: Bite Blocks & Bite Tubes for Trismus

Posted by Deborah Grauzam on



I have an adult woman who has had surgery for oral cancer and has had resection of right hard palate. I have been treating her for Trismus using the TheraBite. This has worked successfully as she was able to wear an obdurator.


She is now at a point where she can no longer wear the obdurator and the TheraBite is therefore not an appropriate tool to help maintain her jaw opening as she has no functional surface to place the TheraBite on her right side. Have you had any experience using the Bite Blocks as a treatment for Trismus?


Thank you for your help in this matter.



Hi Tracy,

I have been using Oral Placement Therapy techniques with adults for many years. Trismus or difficulty with the controlled opening and closing of the jaw is often seen after oral cancer resection and/or radiation treatments. To treat it, I use a combination of the Bite Block Hierarchy and the Bite Tube Hierarchy to increase mobility and opening of the jaw. Bite Blocks work on static opening of the jaw muscles while the Bite Tubes work on dynamic mobility used for speech as well as for feeding. If you are not familiar with these techniques you can learn about them by watching the video of my 2-day class "A Three part Treatment Plan for Oral Placement Therapy."

The success of the program depends not so much on the severity of the truisms but on the compliance of the client. It will be necessary to practice each activity 10 times per day to ensure success.

I have just completed my newest book A Therapist’s Guide to Improving Speech Clarity and Feeding Skills in the Adult Population using Oral Placement Therapy. It is with the publisher now and will be available within the next few months. In it I teach these techniques as well as the other OPT activities I use with the adult population.

I hope this has answered your question,

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask a Therapist: Bite Block Hierarchy Application

Posted by Deborah Grauzam on

I bought the OPT Program, but am struggling with one part of it. I have a child who can hold the bite block #2 between her teeth on the L and R sides for 15 seconds with isometric pull. She can't hold both of the bite blocks between her teeth at the same time with isometric pull (Exercise B) for even one second, though, without demonstrating compensatory strategies (moving head or body forward or pulling up on the chair). I have read and reread the OPT for Speech Clarity and Feeding book looking for what to do next. Page 94 says to make a note of the failure and then proceed to 'Using the Correct Diagnostic Term.' But, in that section, it doesn't tell me what to do. If she fails at having both bite blocks in her mouth with isometric pull, what can I do to strengthen her jaw so that I can then move to bite block #3 for the Bite Block Exercise section?

Without actually seeing the child it is hard to figure out the problem so I will give you some options as any of these can explain the problem:

1. Look at her bite on both sides of her mouth. If she is grinding her teeth or has dental alignment problems that may be the reason she cannot maintain a hold on both bite blocks at the same time. If that is the case then go on to Exercise C - using Bite Block #2.

2. Repeat Exercise A using Bite Block #2. While you are pulling make sure a) you are pulling hard enough, b) she is not tightening her body (even slightly) in any way, as that can also be a compensatory strategy and c) her jaw is not sliding out of alignment (even a little bit). If none of these compensatory behaviors are present, go onto Exercise C - using Bite Block #2.

3. Remember to use the Bite-Tube Hierarchy in conjunction with the Bite Blocks as this activity will also address her jaw instability.


Sara Rosenfeld-Johnson

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